The opening of anal canal called anus, functions as passage for expulsion of stool, sexual organ, peep into the colon by endoscope for diagnosing various diseases and intake orifice for treatment e.g. enemas, suppository. Sexually transmitted diseases (STDs) can be transmitted through anal sex and affect the anorectum. Anal sex is prevalent among men but women also at times have anal sex. Damage to internal and external skin and tissue around anus is occurred during first act of anal sex or during aggressive anal sex. This causes pain and impairs the function.
The abundance of nerve endings in the anal region and rectum makes anal sex pleasurable for many men and women. Some men get pleasure from anal penetration which stimulates the prostate gland.
Many diseases are created by anal sex, some common problems are discussed.
ANAL FISSURE: Presents as a painful tear of anus, occurs when anal sex is done without lubrication, it may bleed and increase the risk of spread of STDs.
HAEMORRHOIDS: Anal sex do not cause piles but may exacerbate them. Frequent anal sex leads to decrease in tone of anus and may cause prolapse of piles or even bleeding.
GONNORRHEA: Caused by gram negative bacterie Neisseria Gonnorrhea. It attacks genital tract, vagina, penis and rectum. It is commoner in males and in men it is contacted during anal sex with infected male, but in females, anal sex as well as extension of infection from vagina to the anal canal can occures. It causes itching, creamy discharge, tenesmus, painful defecation, at times pus with blood. More commonly disease only cause minimal discomfort – just a slight amount of anal moisture and pruritis. Large proportion of the patient are symptoms free. It takes two -seven days after infection to become symptomatic.
Diagnosis is made by history, taking pus for culture and sensitivity and sigmoidscopy showing characteristic mucopurulent pus laden fragile, oedematous mucosa. Treatment is easy as it is sensitive to many routine antibiotics ciprofloxacillin, ofloxacillin, terramycin, doxycycline etc.
SYPHILIS: Time old disease presenting in various stages. In anus after a incubation period of two to three weeks it appears as a painless ulcer called Chancre, it may have multiple contact lesions and it may go undetceted. It may have offensive discharge, which cause perianal skin to become sodden. The inguinal glands are enlarged and have ‘rubbery’ feel. These lesion disappears even if not treated after few weeks. At times this primary lesion is painful due to secondary infection and then it has to be differentiated with fissure in ano and squamous cell carcinoma. Diagnosis is made by identifying spirochete under dark ground illumination from the discharge of the ulcer, VDRL and other serological test for syphilis. In second stage rash, fever, lymphadenopathy, numerous coloured skin lesions, lesions resembling anal warts known as Condylomata Lata appears. Inguinal lymph nodes are also enlarged.
Broad based papule are present in anus in this stage and they are full of spirochetes.
Third stage of syphilis is rare and it frequently present as strictures. Gumma of rectum is occasionally encountered.
Syphilis is treated by Penicilins and if patient is sensitive to penicillins – erythromycin and tetracyclines can be used.
CHANCROID: This is also known as soft chancre or venereal sore, caused by Haemophilus Duceryi a gram negative red. It causes painful, irregularly shaped sore, the inguinal lymphnodes are enlarged and called bubo, which may swell up with pus and rupture to form a ulcer. Diagnosis is made by Gram stain of smear, culture and biopsy. Treatment is by single dose azithromycin, erythromycin and trimethoprim.